Provider Demographics
NPI:1427661966
Name:PLANTIKO, ERIK STEVEN (PA-C)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:STEVEN
Last Name:PLANTIKO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2690 NE KRESKY AVE
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-2412
Mailing Address - Country:US
Mailing Address - Phone:360-330-9543
Mailing Address - Fax:360-330-9560
Practice Address - Street 1:1810 STATE HIGHWAY 508
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WA
Practice Address - Zip Code:98570-9636
Practice Address - Country:US
Practice Address - Phone:360-978-6600
Practice Address - Fax:360-978-6610
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-10514363AM0700X
WAPA61574147363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2293840Medicaid